Part 2: The failure to create a failure regime
One of the long term mistakes has been the failure of policy to clearly develop, publish and use a failure regime for the nationâ€™s hospitals. Whatever else we learn from Mid Staffs, we must recognise that a considerable number of local people felt that this hospital was failing them. Yet I am still not clear if, several years later, Mid Staffs is labelled a falling hospital or not.
That fact it has failed is clear. Whether anyone has had to nerve to categorise it in this way is less clear.
This has been a policy area that has been fraught with political failure. Several governments, including the one for which I worked, have failed the public by failing to develop, publish and use a regime that clearly and consistently uses the label â€˜failureâ€™ to describe a hospital.
In 2000 the NHS plan made it clear, not only that there should be a simple red amber and green rating system for the nationâ€™s hospitals, but that there should also be a regime which clearly labelled a hospital as â€˜failingâ€™ and had a policy to deal with that.
But in fact the development and application of this policy over more than a decade has been weak.
Compare this to education – where the first school was labelled as failing 20 years ago.
Letâ€™s look at where we are today.Â South London Healthcare Trust had the administrators sent in because it had failed economically. But the point made by the Public Accounts Committee was that we donâ€™t know the criteria that determined that administrators should be sent into this hospital – and not to any of the others that can only pay their staff because money is stolen from the rest of the NHS to subsidise them.
In quality and safety terms we donâ€™t really know what the failure regime looks like.
Two weeks ago this led the Prime Minister, in his statement in reply to Francis, to ask Monitor to develop what he described as a â€˜unifiedâ€™ failure regime.
We all know why there has been a decade-long failure to construct a failure regime. It is a collective failure of nerve by the political class (including me in my time in Government).
Most of the public believe that all NHS hospitals provide a similar standard of service. As far as they are concerned the NHS brand is a badge which guarantees both quality and their safety.
ALL of us in the system have long known this is not true.
But it took a catastrophe like Mid Staffs to acknowledge this.
Itâ€™s true that some Government policy helped patients at Mid Staffs. In the past they would have had to keep going to the hospital because they had no choice. Developing the policy which gave patients the choice to go to a different hospital was hugely controversial. It took row after row with the various aspects of the NHS to say that the public had the right to choose where to go.
This is one area where I donâ€™t have to apologise because we faced down that opposition and implemented a policy of choice.
What did this mean for people at Mid Staffs?
On February 10th BBC news carried an interesting report on a Freedom of Information request. This had been published on the BBC Stoke and Staffordshire web site. Â This showed that the current CEO of Stafford hospital had found that the number of patients who had chosen to go there through the â€˜choose and bookâ€™ system had fallen from 15740 in 2007/8 to 6513 in 2012/13.
This is a really significant statistic. Because people could choose two third chose not to go.
It is the case that many outside the NHS may find it very odd that as many people as 6513 are choosing to go to a hospital which has been so systematically labelled as bad.
This is the first time I have seen a set of figures which so powerfully demonstrate the choice of the public not to go to a certain hospital. 2 people out of 3 are choosing not to go to Mid Staffs compared to 5 years earlier.
These choices are costing the hospital Â£3.7 million a year and will be one of the reasons why Monitor has had to look carefully at whether the hospital has a future.
The policy of choice enshrined in the NHS constitution gave people the right not to go to a certain hospital, but because we did not have the nerve to develop and implement a failure policy, we left it all up to the individual.
I am pleased that we gave people choice. But I am ashamed that weÂ didn’tÂ clearly say that failure was failure and decisively act upon it wherever and wherever it took place.